Matthew Julian Wideroff, M.D.

Surgery Physician · Palm Coast, FL

Individual Active NPI

NPI number 1134448129

Practice location

61 Memorial Medical Pkwy Ste 3805
Palm Coast, FL 32164-5982
Phone
(386) 586-1605
Fax
(386) 586-1607

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NPI record

NPI
1134448129
Entity type
Individual (Type 1)
Enumeration date
May 31, 2010
Last updated
August 7, 2024
Certified
August 7, 2024
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Surgery Physician Primary 208600000X ME167382 FL
Surgery Physician 208600000X 9934 SD

Mailing address

PO Box 935921
Atlanta, GA 31193-5921

Other practice locations (1)

  • 2805 5th St, Rapid City, SD 57701 · (605) 755-5700

About Dr. Wideroff

Matthew Julian Wideroff, M.D. is a healthcare provider registered in the NPI registry with the primary taxonomy Surgery Physician (code 208600000X). The practice location is 61 Memorial Medical Pkwy Ste 3805, Palm Coast, FL 32164-5982. The NPI number 1134448129 was assigned on May 31, 2010 and the record was last updated on August 7, 2024.

Dr. Wideroff lists 2 licenses in the registry: #ME167382 (FL) for Surgery Physician; #9934 (SD) for Surgery Physician. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Matthew Julian Wideroff, M.D.?

The NPI number is 1134448129.

What is the phone number of Dr. Wideroff?

The phone number listed for the practice location is (386) 586-1605.

Where is Dr. Wideroff located?

61 Memorial Medical Pkwy Ste 3805, Palm Coast, FL 32164-5982.

What is the taxonomy code for Dr. Wideroff?

The primary taxonomy code is 208600000X – Surgery Physician; 1 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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